Physician Associate / Assistant vs Nurse Practitioner

The world needs more physician associates (f.k.a. physician assistants) and more nurse practitioners. The retirement of the Baby Boomer generation has led to a major warp in the demographics of America, creating an aging population that needs a greater amount of medical attention. While the education requirements for medical doctors cause a glut in the pipeline of potential caregivers, the need for the skills of physician associates (PAs) and nurse practitioners (NPs) is growing further. According to the Bureau of Labor Statistics (BLS), both professions are set to grow at a blistering pace that’s around four times the national average for all careers.

To the unitiated, physician associates and nurse practitioners seem to serve a similar role, performing many of the general tasks a doctor would perform: prescribing medication, ordering medical tests, and designing treatment plans. They’re not just nurses and assistants, but they’re not quite medical doctors either. So what are they exactly and what’s the difference between them?

While there’s a lot of overlap between the two positions, think of it like this: physician associates go wide, and nurse practitioners go deep. Physician associates are trained to treat a broad spectrum of patients, while nurse practitioners target a specific population. It starts in school, where physician associates get a broader education in their graduate programs and nurse practitioners go deep into an area of focus. This is also reflected in the certification process, where physician associates take a generalist examination for licensure, while nurse practitioners often pursue advanced population-specific certifications. It’s generally easier to switch specialties as a physician associate because a nurse practitioner will need to undergo more formal training requirements and additional certification steps.

But it’s also not quite that simplistic. The differences between these two roles are more nuanced than a sweeping generalization. Subtle variations exist in educational requirements, prescriptive authority, and licensing requirements. Further variation occurs based on one’s specialty, area of practice, and state of residence. To learn more about the way these professions deviate and overlap, check out our side-by-side comparison chart below.

Side-by-Side Comparison: Physician Associate / Assistant vs Nurse Practitioner

Physician Associate (PA) Nurse Practitioner (NP)
Education Physician associates will need a bachelor’s degree, as well as a master’s degree (MPAS, MHS, or MMSc) from a PA school. In addition to a bachelor’s degree in nursing (BSN), over 99 percent of nurse practitioners have either a master’s degree (MSN) or a doctorate (DNP).
Timeline to Practice In order to practice, a physician associate will typically need a four-year bachelor’s degree, a two-to-three-year master’s degree, and three years of healthcare experience. Allowing for some overlap, the general timeline to practice is between seven to ten years. In order to practice, a nurse practitioner will typically need a four-year bachelor’s degree and a two-to-four year graduate-level degree. As a general range, the timeline to practice for nurse practitioners is six to eight years.
Typical Duties While a physician associate’s duties will vary depending on their specialization and location, a general list would include:
  • Developing treatment plans
  • Conducting physical exams
  • Assisting in surgery
  • Taking medical histories
  • Performing clinical research
  • Ordering, performing, and interpreting medical tests
  • Prescribing medications
While a nurse practitioner’s duties will vary depending upon the regulations in their state, a general list would include:
  • Diagnosing and treating both acute and chronic conditions
  • Educating patients and their families on healthy habits and disease prevention
  • Maintaining detailed patient records
  • Ordering, performing, and interpreting medical tests
  • Prescribing medications
Can Prescribe Medications? Physician associates are able to prescribe medications in all 50 states, but the specific nature of that prescriptive authority can vary from state to state. As of late 2019, in 47 states, the scope of that prescriptive authority is determined by the supervising physician. Seven states place some regulatory limits on the scope of that authority, particularly regarding the prescription of schedule II and legend substances. Nurse practitioners are able to prescribe medications, including scheduled substances, in all 50 states. The specific nature of that prescriptive authority, however, can vary. Some states require that nurse practitioners have “collaborative relationships” with a specific supervising physician in order to prescribe medication. Nurse practitioners may also need to undergo a probationary period and register with the DEA.
Common Practice Settings According to the BLS (2019), over 50 percent of physician associates work in physician offices and clinics, just over a quarter work in hospitals, and 8 percent work in outpatient care centers. According to the American Association of Nurse Practitioners (AANP), over two-thirds of nurse practitioners work in family care, both in outpatient clinics and primary care settings. They can also work in acute care inpatient settings.
Licensing and Certification Physician associates need to be both state-licensed and certified in order to practice. Certification requires one to pass the 300-question Physician Assistant National Certifying Exam (PANCE), which is administered by the National Commission on Certification of Physician Assistants (NCCPA). Those who pass the exam are eligible to use the Physician Assistant-Certified (PA-C) title.
For state licensure, each state has its own eligibility requirements. More information can be found on the American Academy of Physician Associates (AAPA) website.
Nurse practitioners need to be licensed as both a registered nurse (RN) and a nurse practitioner (NP) in their state. Further certifications and their requirements will vary by specialty and location. The most common certifying organizations are:
  • American Nurses Credentialing Center (ANCC)
  • American Academy of Nurse Practitioners (AANP)
  • American Association of Critical Care Nurses (AACN)National Certification Corporation (NCC)
  • Pediatric Nursing Certification Board (PNCB)
Continuing Education Requirements In order to maintain their certification and licensure, physician associates are required to complete 100 hours of continuing medical education (CME) every two years. Furthermore, they’ll need to pass the Physician Assistant National Recertification Exam (PANRE) every ten years. The quantity and cadence of continuing nursing education (CNE or CE) required for nurse practitioners will vary by state and specialty.
Generally speaking, state APRN licenses need to be renewed every one to two years, while specialty certifications are valid for one to five years. The precise amount of CNE required will vary widely. ANCC certifications, for example, are valid for five years, and typically require 75 hours of CNE to renew.
Specializations Physician associates can pursue specialization in many different areas, with some of the most popular being:
  • Family medicine
  • Surgical subspecialties
  • Emergency medicine
  • Internal medicine subspecialties
  • Internal medicine (general practice)
  • Dermatology
  • Hospital medicine
  • General surgery
  • Pediatrics
  • Obstetrics and gynecology
Nurse practitioners can pursue specialization in many different areas, including:
  • Adult-gerontological health (primary or acute care)
  • Pediatric health (primary or acute care)
  • Family health
  • Neonatal health
  • Mental health
  • Women’s health and gender-related
  • Oncology
  • Emergency medicine
  • Forensic nursing
Salary According to the BLS (2018), there are 114,710 physician associates currently working in the US, with an average salary is $108,430 per year. To break that down further:
  • The 10th percentile makes $69,120 per year
  • The median (50th percentile) makes $108,610 per year
  • The 90th percentile makes $151,850 per year
According to the BLS (2018), there are 179,650 nurse practitioners working in the US, with an average salary of $110,030 per year. To break that down further:
  • The 10th percentile makes $78,300 per year
  • The median (50th percentile) makes $107,030 per year
  • The 90th percentile makes $150,320 per year
Career Outlook (2018-2028) The BLS forecasts that the need for physician associates will grow 31 percent over the next decade, a rate that’s over four times the national average. The BLS forecasts that the need for nurse practitioners will grow 28 percent in the next decade, a rate that’s nearly four times the national average.
Professional Associations and Resources
  • American Academy of Physician Associates
  • National Commission on Certification of Physician Assistants
  • Accreditation Review Commission on Education for the Physician Assistant
  • Journal of the American Academy of Physician Assistants
  • American Association of Nurse Practitioners
  • Gerontological Advanced Practice Nurses Association
  • National Organization of Nurse Practitioner Faculties
  • Nurse Practitioners in Women’s Health
  • National Association of Pediatric Nurse Practitioners
  • Advanced Practitioner Society for Hematology and Oncology
  • National Academy of Dermatology Nurse Practitioners
  • American Academy of Emergency Nurse Practitioners
Matt Zbrog

Matt Zbrog

Writer

Matt is a writer and researcher from Southern California. He’s been living abroad since 2016. Long spells in Eastern Europe, Southeast Asia, and Latin America have made the global mindset a core tenet of his perspective. From conceptual art in Los Angeles, to NGO work on the front lines of Eastern Ukraine, to counterculture protests in the Southern Caucasus, Matt’s writing subjects are all over the map, and so is he.

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